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Review
. 2018 May 12;20(6):35.
doi: 10.1007/s11926-018-0744-2.

Gender Differences in Axial Spondyloarthritis: Women Are Not So Lucky

T Rusman  1 , R F van Vollenhoven  1 , I E van der Horst-Bruinsma  2
Affiliations
Review

Gender Differences in Axial Spondyloarthritis: Women Are Not So Lucky

T Rusman et al. Curr Rheumatol Rep. .

Abstract

Purpose of review: Ankylosing spondylitis (AS) was historically seen as a predominantly male disease. However, more recent data showed a more homogenous sex prevalence. Unfortunately, in many studies in axial spondyloarthritis (axSpA), the number of women included is low and the analyses are often not stratified for gender distribution. The purpose of this review is to aggregate the existing data on gender differences in axSpA in order to increase the awareness that female axSpA patients are still under-recognized.

Recent findings: Several studies considering gender differences revealed that female axSpA patients had different disease manifestations due to different immunological, hormonal, and genetic responses. For instance, allelic frequencies of the AHNK-gene and tissue non-specific alkaline phosphatase (TNAP) haplotypes differed between men and women with ankylosing spondylitis (AS). In addition, different levels of tumor necrosis factor (TNF), interleukins IL-6, IL-17, and IL-18, were found between the two sexes. Furthermore, female patients show a higher diagnostic delay compared to males. Several studies indicate a higher frequency of extra-articular manifestations (EAM) in female axSpA patients, such as enthesitis, psoriasis, and inflammatory bowel disease (IBD), whereas acute anterior uveitis is more prevalent in male patients. Male AS patients more frequently show a higher Bath Ankylosing Spondylitis Radiology Index (BASRI) scores and modified Stoke Ankylosing Spondylitis Spine Scores (mSASSS) than females, which indicates that males have higher radiological damage and radiographic progression. However, disease activity (BASDAI) and quality of life (AsQol) scores are significantly higher in women, and more importantly, they have significantly lower response rates to treatment with TNF inhibitors (TNFi) and a significantly lower drug adherence. Despite the fact that men with axial SpA have a worse radiologic prognosis, women have a high disease burden, in part because they have a longer delay in diagnosis, higher disease activity, and significantly less responsiveness to treatment with TNFi.

Keywords: Axial spondyloarthritis; Disease manifestation; Gender; Radiological progression; Sex; TNF inhibitors.

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Conflict of interest statement

Conflict of Interest

Prof. van der Horst-Bruinsma reports grants from UCB, grants from MSD, grants from Pfizer, personal fees from BMS, and personal fees from AbbVie, outside the submitted work; Dr. van Vollenhoven reports grants and personal fees from AbbVie, grants and personal fees from BMS, grants and personal fees from GSK, grants and personal fees from Pfizer, grants and personal fees from UCB, personal fees from AstraZeneca, personal fees from Biotest, personal fees from Celgene, personal fees from Janssen, personal fees from Lilly, personal fees from Novartis, outside the submitted work; T. Rusman declare that he have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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